Provider Demographics
NPI:1821064742
Name:ANDREWS CENTER
Entity Type:Organization
Organization Name:ANDREWS CENTER
Other - Org Name:ANDREWS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:039-597-1351
Mailing Address - Street 1:PO BOX 4730
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75712-4730
Mailing Address - Country:US
Mailing Address - Phone:039-535-7358
Mailing Address - Fax:
Practice Address - Street 1:2323 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7747
Practice Address - Country:US
Practice Address - Phone:903-597-1351
Practice Address - Fax:903-535-7384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREWS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138365507Medicaid